Individual
MAYRA LICANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4200 ASHE RD, BAKERSFIELD, CA 93313-2029
(661) 809-0837
Mailing address
9821 POCOHONTAS LN, BAKERSFIELD, CA 93311-4604
(661) 428-3670
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCSW103880
CA
1041S0200X
School Social Worker
Primary
LCSW103880
CA
Other
Enumeration date
06/14/2019
Last updated
02/07/2024
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